Psych key points

Question 1

Global memory impairment over a very short period of time with sleep/appetite loss and worried about poor memory

Answer 1

Pseudodementia (Severe depression)

Question 2

Insomnia, irritability, anxiety, tremor, loss of appetite, tinnitus, perspiration, perceptual disturbances, seizures

Answer 2

Benzodiazepine withdrawal syndrome

Question 3

Schneider’s first rank symptoms

Answer 3

Auditory hallucinations, passivity phenomena, thought disorder, delusional perception (sky is blue therefore I am king)

Question 4

Persistent belief in the presence of an underlying serious disease and patient refuses to accept reassurance or negative test results

Answer 4

Hypochondrial disorder

Question 5

Multiple physical symptoms present for at least 2 years and patient refuses to accept reassurance or negative test results

Answer 5

Somatisation disorder

Question 6

Loss of motor or sensory function and the patient doesn’t consciously feign the symptoms or seek material gain

Answer 6

Conversion disorder

Question 7

Separating off certain memories from normal consciousness and involves amnesia, fugue or stupor

Answer 7

Dissociative disorder

Question 8

Selective serotonin re-uptake inhibitors

Answer 8

Citalopram
Fluoxetine - for children and adolescents
Sertraline
SEs - GI bleeding
Interactions - NSAIDs, triptans, aspirin, heparin, warfarin

Question 9

Monoamine oxidase inhibitors

Answer 9

Selegiline
Rasagiline
Not used much
SEs - avoid cheese

Question 10

Serotonin-noradrenaline re-uptake inhibitors

Answer 10

Venlafaxine

Duloxetine

Question 11

Tetracycines

Answer 11

Amitryptiline
Clomipramine
Imipramine
SEs - drowsiness, dry mouth, constipation, urinary retention, blurred vision

Question 12

Typical antipsychotics

Answer 12

Chlorpromazine
Haloperidol - prolonged QT syndrome
SEs - extrapyramidal side effects (Parkinsonism, acute dystonia, tardive dyskinesia, akathisia), antimuscarinic (urinary retention, blurred vision), weight gain, neuroleptic malignant syndrome, increased risk of venous thromboembolism

Question 13

Atypical antipsychotics

Answer 13

Olanzapine
Quetiapine
Clozapine - agranulocytosis

Question 14

Mood stabilisers

Answer 14

Lithium
Sodium valproate
Lamotrigine - during pregnancy

Question 15

Management of generalised anxiety disorder

Answer 15

Step 1 - education about GAD + active monitoring
Step 2 - low intensity psychological interventions (individual non-facilitated self-help or individual guided self-help or psychoeducational groups)
Step 3 - high intensity psychological interventions (CBT or applied relaxation) or sertraline
Step 4 - MDT

Question 16

Management of panic disorder

Answer 16

Step 1 - recognition and diagnosis
Step 2 - SSRIs (if not effective after 12 wks or contraindicated start Imipramine)
Step 3 - review and consideration of alternative treatments
Step 4 - review and referral to specialist mental health services
Step 5 - care in specialist mental health services

Question 17

Difference between mania and hypomania

Answer 17

Grandiose delusions in mania and not in hypomania

Question 18

Looking for personal gain

Answer 18

Factitious/Munchausens

Question 19

Looking for external gain (money, drugs)

Answer 19

Malingering

Question 20

Alcohol withdrawal timeline

Answer 20

6-12 hours - symptoms
36 hours - seizures
72 hours - delirium tremens - give chlordiazepoxide

Question 21

SSRI discontinuation syndrome

Answer 21

Increased mood change, restlessness, difficulty sleeping, unsteadiness, sweating, diarrhoea, vomiting,
paraesthesia

Question 22

SSRIs in pregnancy

Answer 22

First trimester - increased risk of congenital heart defects
Third trimester - persistent pulmonary hypertension of the newborn
Paroxetine has an increased risk of congenital malformations